title: Chronic myeloid leukemia (CML): association of treatment satisfaction, negative medication experience and treatment restrictions with health outcomes, from the patient's perspective.
abstract: BACKGROUND
  The availability of the tyrosine-kinase inhibitor (TKI), imatinib, and later introduction of second generation TKIs, dasatinib and nilotinib, have not only improved clinical outcomes of patients with chronic myeloid leukemia (CML), but also provide multiple therapeutic options for CML patients. Despite the widespread use of these oral therapies, little is known about the impact of different treatment regimens on patient-reported outcomes (PROs) among CML patients. The objective of this study was to assess the impact of patient-reported treatment restrictions and negative medication experiences (NMEs) on satisfaction and other health outcomes among patients with CML treated with oral TKIs.
  
  
  METHODS
  Participants recruited from survey panels and patient networks in the United States (US) and Europe completed an online questionnaire. Respondents included adults (≥ 18 years) with chronic-phase CML currently on TKI treatment. Study variables included treatment difficulty (i.e., difficulty in following treatment regimens), CML dietary/dosing requirements, NMEs, and validated PROs assessing treatment satisfaction, health-related quality of life (HRQoL), activity impairment, and non-adherence. Structural equation models assessed associations among variables, controlling for covariates.
  
  
  RESULTS
  303 patients with CML (US n=152; Europe n=151; mean age 51.5 years; 46.2% male) completed the questionnaire. Approximately 30% of patients reported treatment difficulties; treatment difficulty was higher among nilotinib (63.3%) than among dasatinib (2.6%) or imatinib (19.2%) treated patients (p<0.0001). Non-adherence was generally low; however, patients on nilotinib vs. imatinib reported missing doses more often (p<0.05). Treatment satisfaction was associated with significantly increased HRQoL (p<0.05) and lower activity impairment (p<0.01). NMEs were associated with decreased treatment satisfaction (p<0.01) and HRQoL (p<0.05), and greater activity impairment (p<0.01). Higher overall treatment restrictions were associated with greater treatment difficulty (p<0.001), which correlated with non-adherence (p<0.01).
  
  
  CONCLUSIONS
  Treatment satisfaction and NMEs are important factors associated with HRQoL among patients with CML. Increased treatment restrictions and associated difficulty may affect adherence with TKIs. Choosing a CML treatment regimen that is simple and conveniently adaptable in patients' normal routine can be an important determinant of HRQoL and adherence.
authors.affiliation: Health Outcomes Practice, Kantar Health, Princeton, NJ, USA. shaloo.gupta@kantarhealth.com.
authors.forename: Ishan
authors.initials: I
authors.lastname: Hirji
authors.forename: Shaloo
authors.initials: S
authors.lastname: Gupta
authors.forename: Amir
authors.initials: A
authors.lastname: Goren
authors.forename: Diana R
authors.initials: DR
authors.lastname: Chirovsky
authors.forename: Alyson B
authors.initials: AB
authors.lastname: Moadel
authors.forename: Eduardo
authors.initials: E
authors.lastname: Olavarria
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Victor
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Davis
mesh_terms: D001549:Benzamides / Q000009:adverse effects*; D000069439:Dasatinib; D005060:Europe; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010879:Piperazines / Q000009:adverse effects*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects; D011743:Pyrimidines / Q000009:adverse effects*; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D013844:Thiazoles / Q000009:adverse effects*; D014481:United States
chemical_list: D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013844:Thiazoles; D000068877:Imatinib Mesylate; D000069439:Dasatinib